Nose and Perioral Regions as Difficult Zones

A ranking of difficult facial regions is easy to skim and easy to forget. The nose and the area around the mouth are named in one, and anyone training in Parsippany, New Jersey should know why before a first filler or toxin course.

Where the ranking comes from

PubMed Central hosts a review that ranks facial regions by difficulty and risk. In its words: "The nose and the perioral region have been ranked as the facial regions where it is most difficult to achieve a perfect aesthetic outcome and with the greatest risk for the occurrence of adverse events for filler and toxin injections, respectively."

That sentence makes two separate points. One concerns reaching a perfect aesthetic outcome and the other concerns adverse events. Plan for both, because a clean-looking result does not answer the second question.

Building the vocabulary first

Anatomy study is one way to build that vocabulary. Readers who want a plain reference for the term can look at Wikipedia's entry on the cadaver, and those refreshing names around the mouth can use Wikipedia's general entry on facial muscles.

A check before the first case

Name the ranking out loud before you treat either region. Then write down what you will look at when the patient returns, so follow-up is planned rather than improvised.

For wider reading on what can go wrong with fillers, PubMed Central carries Vascular Complications after Facial Filler Injection: A Literature Review and Meta-analysis.